Journal of Social Distress and the Homeless, Vol. 7, No. 4, 1998 House Demolition and Mental Health: Victims and Witnesses Samir Qouta, 1 Raija-Leena Punamaki, 2,3 and Eyad El Sarraj 1 This research examines the immediate effects of losing one's home and witnessing the demolition of others' houses on the mental health of Palestinian adults and children. The loss group consisted of 47 adults whose homes were demolished, the witness group of 24 adults who witnessed the house demolition, and the control group of 33 adults. The groups were compared for their anxiety, depression, and paranoiac symptoms. In addition, 38 children in the loss group, 36 children in the witness group, and 50 children in the control group were compared for their psychological symptoms. The results showed that adults who were exposed to house demolition showed a higher level of anxiety, depression, and paranoiac symptoms than the witness and control groups. The children in the loss group showed a higher level of psychological symptoms than the children in the witness and control groups. The witness group differed from the control group in having more depression among women and more psychological symptoms among children. Women suffered more from anxiety, depression, and paranoiac symptoms than men in the loss and witness groups but not in the control group. KEY WORDS: traumatic events; political violence; mental health. INTRODUCTION When I returned to my home in the evening, I found it destroyed. The furniture was scattered and broken. I began to weep. At that moment I began to remember the time when we were uprooted from our country, Palestine. We settled in the Khan Yunis camp for 35 years. Then we left the camp to live here in the El Animal 1 Gaza Community Mental Health Programme, P.O. Box 1049, Gaza, Via Israel. 2 Department of Psychology, University of Helsinki, Finland. 3 Correspondence should be directed to Raija-Leena Punamaaki, Department of Psychology, Applied Division, P.O. Box 4 (Fabianinkatu 28), SF-0014, University of Helsinki, Finland. 279 1053-0789/98/1000-0279$15.00/0 O 1998 Human Sciences Press, Inc.
Transcript
Journal of Social Distress and the Homeless, Vol. 7, No. 4, 1998
House Demolition and Mental Health: Victims andWitnesses
Samir Qouta,1 Raija-Leena Punamaki,2,3 and Eyad El Sarraj1
This research examines the immediate effects of losing one's home andwitnessing the demolition of others' houses on the mental health of Palestinianadults and children. The loss group consisted of 47 adults whose homes weredemolished, the witness group of 24 adults who witnessed the housedemolition, and the control group of 33 adults. The groups were comparedfor their anxiety, depression, and paranoiac symptoms. In addition, 38 childrenin the loss group, 36 children in the witness group, and 50 children in thecontrol group were compared for their psychological symptoms. The resultsshowed that adults who were exposed to house demolition showed a higherlevel of anxiety, depression, and paranoiac symptoms than the witness andcontrol groups. The children in the loss group showed a higher level ofpsychological symptoms than the children in the witness and control groups.The witness group differed from the control group in having more depressionamong women and more psychological symptoms among children. Womensuffered more from anxiety, depression, and paranoiac symptoms than men inthe loss and witness groups but not in the control group.
KEY WORDS: traumatic events; political violence; mental health.
INTRODUCTION
When I returned to my home in the evening, I found it destroyed. The furniturewas scattered and broken. I began to weep. At that moment I began to rememberthe time when we were uprooted from our country, Palestine. We settled in theKhan Yunis camp for 35 years. Then we left the camp to live here in the El Animal
1Gaza Community Mental Health Programme, P.O. Box 1049, Gaza, Via Israel.2Department of Psychology, University of Helsinki, Finland.3Correspondence should be directed to Raija-Leena Punamaaki, Department of Psychology,Applied Division, P.O. Box 4 (Fabianinkatu 28), SF-0014, University of Helsinki, Finland.
279
1053-0789/98/1000-0279$15.00/0 O 1998 Human Sciences Press, Inc.
280 Qouta, Punamaki, and El Sarraj
settlement until our home was destroyed. When the soldiers imposed the curfew Ididn't expect them to demolish our home. Their motive was revenge. Wheneverwe achieve a step of progress, Israel forces us to go back.
—60-year-old woman, Gaza
During the Palestinian uprising—the Intifada—the Israeli army fre-quently used house demolitions to frighten and collectively punish thepopulation for its resistance activities.4 When a family is witness to thedestruction of its own home by enemy soldiers, the psychological effect isimmense. The home is not only a shelter, but also the heart of family life.There are memories of joy and pain as well as attachment to familiar ob-jects. Home is associated with feelings of security and consolation.
A great deal of psychological research on organized political violencehas focused on the relationship between exposure to traumatic events andmental health. The procedure for assessing traumatic or stressful experi-ences is based on life-event research, which attempts to establish a causallink between recent or chronically occurring life events and mental andgeneral health problems (Holmes & Rahe, 1967; Goodyer, 1990). Lifeevents such as bereavement, separation, and moving are suspected to exertmajor adverse psychological effects on both children and adults. However,studies that take into account other variables such as pre-event levels ofpsychological functioning have questioned the existence of a relationshipbetween life events and psychological problems. With the exception of clini-cal and retrospective studies, correlations have been found to be relativelymoderate for general samples (Cohen, Burt, & Bjorck, 1987). Rather thanmerely listing different events, it might be more useful to analyze the mean-ings that different hardships present for different people.
In studies dealing with political violence and war, questionnaires areconstructed to correspond to the specific reality in which people live, e.g.,in South Africa (Dawes et al., 1989), Iraq (Dyregrov & Raundalen, 1993),Lebanon (Macksoud, 1989; Mahjoub, 1990), and the occupied West Bankand Gaza strip (Punamaki, 1986). Political trauma or stress is usually as-sessed using a global measurement without a distinction being made be-tween the impact of traumas of different kinds on psychological well-being.Theoretical and clinical literature propose, however, that the nature of thetraumatic experience is decisive in predicting the nature and severity ofpsychological problems. For instance, loss has been associated with depres-
4The term collective punishment is used to refer to a range of actions directed against thecommunity as a group. It includes curfews, demolishing neighborhoods, deportations, andclosures of areas. In the Gaza strip, 268 houses were completely and 121 partly demolished,and 71 homes were sealed in the years 1988-1992 (UNRWA, 1992). During the first 2 monthsof 1993, the Israeli army demolished 51 houses in the Gaza strip (JMCC, 1993).
House Demolition and Mental Health 281
sive symptoms, threat with anxiety, and frustration with aggression (Bowlby,1973; Dollard et al., 1939).
Some empirical studies support the assumption that the nature oftraumatic experiences prescribes the nature and severity of psychologicalproblems. Bryce, Walker, and Peterson (1989) studied the importance ofthe nature of different life events in predicting depression among WestBeirut women during the 1982 Lebanon war. Of the war-related events,only displacement from home increased depression. Researchers con-cluded that events related to the ongoing war affected the women's mentalhealth only when they impinged on their daily lives. A study of Israelichildren showed that political hardships such as shelling and explosionsincreased psychological symptoms of anxiety and depression, but were notrelated to problems like family difficulties or lack of social support (Pu-namaki, 1995). However, research is still scarce about how the nature,severity, or timing of war-related traumatic experiencies influence mentalhealth.
This article focuses on the question of how the nature and severity ofa traumatic event affects the mental health of children and adults. Pales-tinians whose homes were demolished, Palestinians who witnessed thedemolition of houses, and a control group were compared for their anxiety,depression, and paranoiac symptoms. The children belonging to thesegroups were compared for their psychological symptoms. According to spe-cific effect of loss and threat, we may hypothesize that losing one's homewill result in depressive symptoms, and witnessing of the destruction of oth-ers homes will result in anxiety.
METHOD
Subjects
The groups studied were (a) the loss group of 47 adults (mean age 33± 13) and 38 children (mean age 8.7 ± 2.2) whose homes were demolishedwhile living in the El Ammal housing settlement in the south of the Gazastrip, and (b) the witness group of 24 adults (mean age 30 ± 12) and 36children (mean age 8.8 ± 2.4) who witnessed the demolition of the homesin El Ammal. The control group (c) consisted of 33 adults (30 ± 9.9) and50 children (9.1 ± 2.1) living in their homes in another housing settlement,Bait Labia, in the north of the Gaza strip about 45 km from the demolishedarea. The control group was collected by using systematic sampling (Ped-hazur & Schmelkin, 1991) in which, following a random start (naming a
282 Qouta, Punamaki, and El Sarraj
house in the settlement), every third house of that street was chosen to bestudied.
Procedure
On the tenth of February 1993 at 4:00 am, the Israeli army surroundeda neighborhood in the El Ammal housing project and ordered all the peo-ple to leave their homes. Then, soldiers machine-gunned their way into thehouses. In the process, they destroyed furniture and other belongings ofthe families. Before leaving, they exploded dynamite in order to damagethe house structures. Finally, anti-tank rockets were fired to complete thedemolition. The 31 families who became homeless were provided with tentsby UNRWA.
The loss group of this study consists of those people who lost theirhomes in this incident; the witness group consists of the El Ammal peoplewho observed this destruction. Both groups were interviewed during the10 days after the disaster by two experienced field workers. The interviewstook place in the ruins of their houses or in tents.
Measures
For the adults, the Taylor Manifest Anxiety Scale was used. It consistsof 50 items, each describing a certain type of behavior or symptom indi-cating anxiety. Reliability of the test has been found to range between 0.81-0.92 in Arab populations (Souife, 1976).
The MMPI (Minnesota Multiple Personality Inventory) Depression testwas administered. It consists of 60 items that measure symptomatic depres-sion, e.g., general attitude characterized by poor morale, lack of hope inthe future, general dissatisfaction with one's life, a lack of interest in ac-tivities expressed as general apathy, excessive sensitivity, lack of sociability,and some physical symptoms.
The MMPI Paranoia test consists of 40 items that are clearly orientedtoward identification of psychotic behavior, acknowledging the existence ofdelusions and paranoid thought processes.
The parents were interviewed for the children's Psychological symp-toms. The 24 items from the Rutter (1987) scale were used. This scale cov-ers various behavioral as well as emotional problems and neuroticsymptoms in children. Four questions relevant to Palestinian children wereadded: if the child is afraid of the army, reexperiencing the traumatic event,afraid to go out, or suffering from choking.
House Demolition and Mental Health 283
RESULTS
Adults
Means of anxiety, depression, and paranoiac symptoms for the adults,were compared between the loss, witness, and control groups and betweenmen and women by using a two-way ANOVA test. Whenever a significantF-ratio was found, the means were compared using T-tests. The ANOVAmain effects and interactions of sex and nature of trauma on psychologicalproblems are presented in Table I.
Results show that adults exposed to different types of traumatic expe-riences differ significantly in their anxiety, depression, and paranoiac symp-toms. The loss group showed the highest level of symptoms, and differedvery significantly from the control group and significantly from the witnessgroup. The witness group differed from the control group significantly onlyin depressive symptoms (t = 2.50, p < 0.01), but not in anxiety and para-noiac symptoms.
The interaction effects of the nature of the trauma and sex on psy-chological problems showed that women expressed more anxiety and de-pression than men in the loss and witness groups, whereas no sexdifferences were found in the control group.
In the adult group, age was not significantly related to the psychologi-cal symptoms (r = 22,p = ns for anxiety, r = 21, p = ns for depression,and r = 14, p = ns for paranoiac symptoms).
Table I. Scores (Mean, SD) of the Adults' Anxiety, Depression and ParanoiaAccording to the Nature of Traumatic Experience and Sexa
Loss group
AnxietyMenWomen
DepressionMenWomen
ParanoiaMenWomen
Mean
28.526.929.9
24.623.125.9
17.515.519.1
SD
8.39.77.1
5.35.25.2
5.14.35.3
Witness group
Mean
21.619.022.5
19.615.321.0
14.512.515.2
SD
6.97.16.9
6.57.25.7
5.96.25.9
Control group
Mean
19.220.218.8
15.816.515.5
12.213.611.6
SD
7.29.26.4
4.14.14.2
3.34.02.9
F
15.37*
27.16*
11.6*
aLevel of significance, df = 2,103.•p < .001.
284 Qouta, Punamaki, and E1 Sarraj
Children
Children whose homes were demolished showed significantly morepsychological symptoms than the children in the witness and control groups(F = 72.14, df = 2,118, p < 0.001). Also, the children in the witness groupshowed significantly more symptoms than the control group (t = 4.20, p< 0.0001).
Age and sex of the child were not significantly related to the psycho-logical symptoms in any of the studied groups.
Table II shows that the most common symptoms in the loss group weredread of the army (97%), diminished concentration (84%), constant weep-
Table II. Children's Psychological Symptoms in the Loss, Witness,and Control Groups (%)a
Type of the symptom
Dread of the armyLack of concentrationConstant weepingEasily irritatedReexperiencing traumaNight terrorLoss of interestSleeping difficultiesExplosive and touchyClinging behaviorDisobedienceAfraid of going outSad moodAggressive behaviorFeeling suffocationBed-wettingSocial withdrawalSucking thumbBiting nailsBeating siblingsBulling peersEating difficultiesInvoluntary movementsTelling liesSpeech problemsSomnabulismEncopresisStealing
ing (66%), and reexperiencing the traumatic event (63%). The most com-mon symptoms in the witness group of children were dread of the army(78%), being easily explosive and touchy (52%), and night terrors (42%).The table further shows that the compared groups did not differ signifi-cantly from each other in symptoms like eating difficulties, involuntarymovements, telling lies, speech problems, encopresis, and stealing (p = ns.)These symptoms characteristically indicate severe childhood pathology andpossible personality disorder. They were low in the sample, and the expe-riences of losing one's home or witnessing destruction did not immediatelyincrease their occurrence.
DISCUSSION
The article reports the mental health findings of adults and childrenwho lost their own homes by demolition, those who witnessed other peo-ple's home demolitions, and people who neither lost their homes nor wit-nessed the demolitions. The results showed that both adults and childrenwho lost their homes suffered more severely from psychological symptomsthan the witness and control groups.
The witness group differed from the control group only in their higherlevel of depression. In fact, only women in the witness group expressedmore depression than the controls. It is sometimes argued that witnessingviolence is as traumatic as being its victim. Pynoos (1990) concludes thatexposure to direct violence or the witnessing of violent acts may lead toposttraumatic stress disorders and other symptoms. Our study did not sup-port the notion that the effects of witnessing and direct exposure to vio-lence are equally traumatic. It was evident that the loss group experiencedpsychological symptoms more acutely than the witnesses. On the otherhand, concerning children's psychological symptoms and women's depres-sion, the witness group showed a higher level of psychological sufferingthan the control group. This result indicates that people witnessing violenceare also psychologically vulnerable and traumatized.
Depression was especially high in the loss group; which may be inter-preted as an indication of the specific effect of the loss of one's home: lossleads to depression. According to our hypothesis, witnessing violence anddestruction would give rise to anxiety due to its threatening nature. Thewitness group did not, however, show a higher level of anxiety than theother groups, counterindicating a specific psychological effect of threat ofviolence.
Women expressed more mental health problems than men in the lossand witness groups, which is in accord with earlier research (Brown & Har-
286 Qouta, Punamaki, and El Sarraj
ris, 1978). However, no sex differences were found in the control group.The result indicates that in traumatic conditions, the women's mentalhealth is especially vulnerable.
The study setting can be criticized in that it fails to document the psy-chological meaning that people themselves give to their traumatic experi-ences. In stress research, it is generally accepted that the meaning givento, and the appraisal of, traumatic experiences are important to their out-come. Individuals develop psychological symptoms as a consequence oftheir psychological appraisal of the world (Lazarus & Folkman, 1987).
The interviews give us some hints about the specific meaning that thesubjects attach to the loss of their homes. First, losing one's home meansmore than an acute disaster for the Palestinians since it evokes the memo-ries of the traumatic experiences associated with being a refugee. The 1948war and losing the homeland have been a central focus of fear and inse-curity which deeply affects the inner layer of the Palestinian psyche (ElSarraj, Tawahina, & Abu Hein, 1991).
Second, events that happen suddenly, without prior notice, are con-sidered to be the most traumatic for human beings. The methods used bythe occupying Israeli army in the demolition are psychologically devastat-ing: demolitions are generally carried out at night. A large number of sol-diers in armored vehicles surround the house and shout for the family toget out. Residents may be given only minutes to remove their belongingsbefore the demolition. However, while many people emphasized the suddenand unexpected nature of the demolition, they were also conscious thatthe act happens in the context of a national struggle. In that context, thehouse demolition is a humiliating experience.
Third, demolitions have meant that families have had to live in tentsor in the houses of relatives. This naturally has caused practical and socialproblems. A father described his situation: "What has happened is a ca-tastrophe for our family. When we left our home, we did not expect thatthe army would demolish it. Home means life and security. I am unableto work while my family is still living in a tent by the roadside. Two of mychildren have difficulties sleeping and eating."
For children, home fulfils a basic vital need and makes it possible toestablish a secure and adaptive human relationship. The protective shieldthat is essential for children's mental health is dramatically destroyed whenfaced with house demolition. Also, the fact that Palestinian parents arereduced to helpless victims in front of their children by enemy soldiers mayhave a negative effect on the child-parent relationships. Faten, a 12-year-old boy revealed that negative experience: "When I woke up in the morningI found soldiers shooting: I became afraid and looked for my father. I beganto wonder about how we would live in the future. After the demolition, I
House Demolition and Mental Health 287
dreamt of soldiers raiding my home. They shot the members of my grand-father's family, then they shot my nephew. As our home is inside the set-tlement, they did not enter our home, but in the morning I found that allmy relatives had been killed. After one week I had a similar dream."
ACKNOWLEDGMENTS
We are grateful to Amal Juda and Ala' Harara for their excellent field-work and to Ranya Bakr for her statistical analysis of the data.
REFERENCES
Bowlby, J. (1973). Attachment and loss: Separation, anxiety and anger. New York: Basic Books.Brown, G. W., & Harris, T. (1978). Social origins of depression; a study of psychiatric disorders
in women. London: Tavistock Publications.Bryce, J., Walker, N., & Peterson, C. (1989). Predicting symptoms of depression among women
in Beirut: The importance of daily life. International Journal of Mental Health, 18, 57-70.Cohen, L. H., Burt, C. E., & Bjorck, J. P. (1987). Life stress and adjustment: effects of life
events experienced by young adolescents and their parents. Developmental Psychology, 23,583-59Z
Goodyer, I. M. (1990). Family relationships, life events and childhood psychopathology.Journal Child Psychology and Psychiatry, 31, 161-192.
Holmes, T., & Rahe, R. (1967). Introduction to life-stress scale. Journal of PsychosomaticResearch, 37, 1239-1243.
Dawes, A., Tredoux, C., & Feinstein, A. (1989). Political violence in South Africa: Some effectson children of the violent destruction of their community. International Journal of MentalHealth, 18, 16-43.
Dollard, J., Miller, N. E., Dood, L. W., Mowrer, O. H., & Sears, R. R. (1939). Frustrationand aggression. New Haven: Yale University Press.
Dyregrov, A., & Raundalen, M. (1993). A Longitudinal Study of War-Exposed Children inIraq. Presented at The International Conference on Mental Health and The "Challengeof Peace," Gaza, September 13-15.
El Sarraj, E., Tawahina, A. A., & Abu Hein, F. (1991). The Palestinian: The Story ofUprooting. Presented at The First International Conference on the Mental Health andPsychosocial Wellbeing of Refugees and Displaced Persons, Stockholm, Sweden, October6-11.
JMCC (1993). Jerusalem Media & Communication Centre, Weekly Reports, January-February.
Lazarus, R. S., & Folkman, S. (1987). Transactional theory and research on emotions andcoping. European Journal of Personality 1, 141-169.
Macksoud, M. (1989). The Childhood War Trauma Questionnaire. Children and war researchproject. Columbia University.
Mahjoub, A. (1990). Approache Psychosociale des Traumatismes de Querre Chez les Enfantset Adolescents Palestiniens. Doctorate dissertation, University of Leuven Nouvelle.
Pedhazur, E. J., & Pedhazur Schmelkin, L. (1991). Measurement, design, and analysis. Anintegrated approach. Hillsdale, NJ: Lawrence Erlbaum Associates, Publishers.
Punamaki, R. (1986). Stress among Palestinian women under military occupation; women'sappraisal of stressors, their coping modes, and their mental health. International Journalof Psychology, 21, 445-462.
288 Qouta, Punamaki, and El Sarraj
Punamaki, R. (1995). Can ideological commitment protect children's psychosocial wellbeingin conditions of political violence? Child Development.
Rutter, M., Shaffer, D., & Shepherd, M. (1975). A multi-axial classification of child psychiatricdisorders. Geneva: WHO.
Souife, A. (1976). Social psychology. Cairo: El Anglo (in Arabic).UNRWA (1992). Information Notes. UNRWA, Gaza.
